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Clinico-pathological correlation was carried out in 25 and 65 cases of normal and hypertensive disorders of pregnancy respectively. It was observed that blood urea levels were elevated in the presence of severe glomerular lesion and serum uric acid levels had direct correlation with the magnitude of the glomerular change as well as the clinical severity of the disease. Renal histology in toxaemia when viewed by light microscopy is placed in the non-specific category of acute membranous glomerulo nephritis and does not help much to differentiate the hypertensive disorders of pregnancy from each other. The clinical diagnosis of preeclamptic toxaemia (PET) was misleading in 21.4% of multi-gravidae and 5.2% of primigravidae. It was felt that clinical presentation of the individual case, her previous history coupled with renal function test give the maximum help in arriving at the diagnosis.

Mitral valve prolapse (MVP) is considered to be the most common valvular heart lesion in adult females of reproductive age. Our report reviews the obstetrical performance and outcome of 34 pregnancies in 15 women with MVP. In 12 (80%) patients cardiac lesion was suspected due to enigmatic dyspnoea and palpitation during antenatal period. Four mothers required propranolol for cardiac arrhythmias. However, all of them tolerated pregnancy and labour well. Four pregnancies (11.8%) ended in spontaneous abortion and 1 mother had intrauterine fetal death due to severe pregnancy-induced hypertension. There were 25 (73.5%) term and 3 (8.8%) preterm neonates without congenital abnormality. One preterm neonate had tracheo-oesophageal fistula and died 6 hours after corrective surgery. The mean birth weight of 2.8 kg was appropriate for mean gestation of 38.5 weeks when compared to the Institute's reference neonatal weight curve. Infective endocarditis prophylaxis was recommended in cases having mitral regurgitation and complicated delivery. Awareness of this common cardiac lesion, thorough cardiovascular examination during pregnancy, early detection and treatment of cardiac arrhythmias if any, are the essential steps to prevent rare but dreaded maternal complications.

A rare case of bleeding from oesophageal varices complicating pregnanc-, without an- intrahepatic or extra-hepatic patholog- has been reported and the differential diagnosis has been discussed.

A study has been presented of a 21 year old female Para 1 +1+0+1, who had delivered prematurely a viable baby along with extensive molar degeneration of placenta. The authors emphasized that the practising clinicians should always bear in mind a possibility of hydatidiform mole degeneration of the placenta coexisting with pregnancy which may have an innocuous clinical presentation but the complications afterwards may be the same as in a pre-diagnosed case.

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal live births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and "other reasons," opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

To determine the efficacy and side effects of a single dose of tinidazole for infection following vaginal hysterectomy.A randomized double-blind placebo-controlled trial using 2 g tinidazole 12 h before vaginal hysterectomy in 50 patients was conducted. No other antibiotic was used until the development of infection.There was a significant reduction (P0.01) of post-operative vaginal cuff cellulitis (54-16%). A similar reduction (P0.05) in febrile morbidity was also observed. The duration of postoperative hospital stay (P0.001) and use of additional antibiotics (P0.01) were also reduced. No adverse effect of tinidazole was noted.A single dose of tinidazole appears to be a safe and effective alternative prevention against infection in vaginal hysterectomy.

A multicentred clinical trial was conducted in 12 countries to assess the contraceptive efficacy and side effects of a low-dose levonorgestrel-releasing vaginal ring. Contraceptive efficacy and side effects, expulsions and removals, and the relation between pregnancy rate and admission body weight of the women have been reported previously. The effect of ring use on vaginal bleeding patterns as observed from daily menstrual diaries kept by the women is the object of this paper. A total of 1005 women were fitted with the ring and 702 of them provided a menstrual diary suitable for analysis. The description of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition the longest bleeding/spotting episode and longest bleeding/spotting-free interval are calculated over the entire diary length. Half of the ring users have vaginal bleeding patterns similar to normal untreated patterns. A quarter experience irregular bleeding, 10% have prolonged cycles and 10% have shortened cycles. Over one year of continuous use, there appears to be no significant trend in these patterns. Users with the worst bleeding patterns tend to discontinue first during the clinical trial and are influenced by their more recent experience of vaginal bleeding irregularities. Life-table analysis of discontinuation rates gives an underestimation of the true incidence of bleeding irregularities. Some comments are made on the limitations of the methods of analysis of menstrual diaries.

In a prospective controlled trial 91 consecutive women with eclampsia were randomly allocated either to a magnesium sulphate and nifedipine regime or to a lytic cocktail and nifedipine group. The type and severity of disease, details of labour and delivery, and the maternal and perinatal outcomes and complications related to the 2 treatment regimens were compared. Recurrence of fits, aspiration pneumonia and sudden hypotension were significantly reduced when patients were treated with the new magnesium sulphate and nifedipine regimen compared with the lytic cocktail plus nifedipine regimen. No patient treated with the new regimen died or had respiratory depression; in the other group there were 2 maternal deaths plus 1 case of severe hypoxic brain damage. No difference was observed in duration of labour or mode of delivery. Perinatal mortality was significantly lower in the magnesium sulphate plus nifedipine treated group. The synergistic action of magnesium sulphate and nifedipine in the dosage employed in this study may be used to reduce maternal and perinatal mortality and morbidity in women with eclampsia.

OBJECTIVE: To determine the changes in serum iron levels, if any, as a biochemical marker of pregnancy-induced hypertension (PIH). METHOD: Fifty-four primigravidas with PIH formed the study group and 20 normotensive primigravidas comprised the control group in a prospective study. Serum iron levels were estimated at diagnosis of PIH, at termination of pregnancy and in the postpartum period. Data was analyzed using Student's t-test, the X2-test and regression analysis. RESULTS: Subjects with PIH were found to have higher serum iron levels at diagnosis of PIH (recruitment value) and at termination of pregnancy than the controls (P < 0.001). Serum iron levels in the PIH subjects decreased markedly in the postpartum period simultaneously with the clinical recovery from PIH. Serum iron values of ≥ 110 gg/dl was found to differentiate PIH from normotensive pregnancies with a sensitivity and specificity of 89% and 90%, respectively. CONCLUSIONS: Changes in serum iron levels correlated with the clinical course of PIH and appeared to be a uniform and specific biochemical marker of PIH although its correlation with the severity of PIH was found to be poor.

EDITORIAL COMMENT": We accepted this paper for publication to remind readers of the different types of nonobstetric trauma to the lower genital tract. The mechanism of tearing in the upper vagina during coitus is debated; this report does not favour the theory that tearing in the unsupported upper vagina results from levator spasm rather than direct injury (A). A. Ahnaimugan S, Asuen MI. Coital laceration of the vagina. Aust NZ J Obstet Gynaecol 1980; 20: 180–181. Summary: In a 4-year-period there were 31 admissions to Nehru Hospital, because of nonobstetrie injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.

A 35-year old multiparous woman was admitted at 19 weeks gestation with rapid onset of dyspnoea which progressed to grade 3 in 2 months. She was diagnosed with a case of idiopathic pulmonary fibrosis (IPF). She had a vital capacity of 1.25 1 46.5% of predicted and PaO2 of 60 mmHg at rest which dropped to 35 mmHg on mild exercise testing. She did not respond to prednisolone 40 mg daily given orally for 1 month. In view of the lack of improvement therapeutic abortion was carried out at 24 weeks by abdominal hysterotomy combined with a tubal ligation. subsequent to termination of pregnancy her clinical status and pulmonary function improved markedly and she had only grade 1 dyspnoea 30 months later without corticosteroids. The effect of pregnancy on interstitial lung disorders especially IPF is not yet clear because of the extreme rarity of their association. Therapeutic abortion should be seriously considered in patients who cannot increase their own oxygen consumption 3 times normal without uncorrectable hypoxemia. (authors)

A daily regimen of rifampicin (450 mg) and isoniazid (300 mg) was tried for 9 months in 14 women with histologically diagnosed endometrial tuberculosis (TB). Follow-up endometrial biopsies were negative for tubercular disease in all patients. Three (21.4%) of the 14 women conceived between 3 and 12 months after starting treatment.

The effect of steroidal oral contraceptive (SOC), comprising megestrol acetate (5 mg/kg body weight) plus ethinyl estradiol (0.05 mg/kg body weight), administered daily by stomach tube for 5, 15, 30 and 90 days, on the intestinal uptake of nutrients such as glucose, amino acids and calcium has been investigated in vitro in female rats. The administration of SOC for 5 days did not affect the uptake of nutrients, but treatment for 15, 30 and 90 days led to a progressive and significant increase in the uptake of glucose and amino acids. The calcium uptake was increased in the groups treated for 5 and 15 days, but decreased after 30 and 90 days of treatment. Kinetic studies done on glucose uptake indicated that the steroid contraceptive might be inducing the transport carrier protein of this nutrient, as elevation in Vmax was observed in the group treated for 30 days. There was no change in brush border membrane phospholipid and cholesterol contents after 30 and 90 days of treatment, but a significant increase in phospholipid after 5 and 15 days of treatment was observed. This study suggests that SOC treatment significantly altered the intestinal absorptive functions and the effect appears to be on the carrier-mediated transport of glucose.

Of 1184 cases with previous cesarean section, 590 were selected for trial of vaginal delivery and 594 for repeat cesarean section. Of the former group, 76.6% had successful vaginal delivery. Incidence of uterine wound dehiscence and of perinatal mortality was highest in cases with primary classical cesarean section. Factors like indications for previous cesarean section, history of intercurrent vaginal delivery, weight of baby and period of gestation had positive correlation with delivery outcome.

Five cases of rudimentary horn pregnancy are discussed. Two presented as acute ruptured ectopic pregnancy, whereas in 3 the pregnancy was advanced and intact with intrauterine death of the fetuses. The diagnostic difficulties are discussed and in centres where ultrasound facilities are not available, a high index of suspicion in nonresponders to oxytocin induction is emphasized.

The role of surgery in the management of postabortum renal failure complicated with extensive uterine sepsis, perforation or peritonitis is controversial. This study compares the course and final outcome of 14 patients (66.6%) conservatively managed with appropriate antibiotics, fluid or blood replacement and dialysis, with seven patients (33.3%) for whom hysterectomy or laparotomy was undertaken in addition. Whereas all 14 patients treated conservatively died as the result of uncontrolled septicemia, three of the seven surgical patients recovered completely. Extensive necrosis with perforation of the uterine wall was confirmed either at laparotomy or at autopsy in all 21 women. To reduce mortality, the authors recommend early surgical intervention for patients suffering from post-abortum renal failure complicated with uterine sepsis or perforation.

EDITORIAL COMMENT: Midtrimester abortion using hypertonic saline (20% sodium chloride) was used extensively in the I950's-1960's and was abandoned because of maternal deaths associated with seizures, hypernatraemia and coagulation failure, presumably due to accidental intravenous injection of the solution (or its rapid absorption into the intravascular space) resulting in cerebral infarction or haemorrhage (1,2). Intraamniotic instillation of 20% NaCl or 50% glucose was advocated as late as 1966–1969 for induction of labour in cases of intrauterine death, missed abortion, or therapeutic abortion beyond 14 weeks' gestation (3,4). It should be emphasized that normal saline (0.9% sodium chloride) is a physiological, isotonic solution which should have no such ill-effects. It is always difficult to judge 2 solutions such as described in this paper when the regimens are complicated by use of Syntocinon infusion, which was commenced in both study groups 2 hours after extraamniotic instillation of the 2 solutions whose abortificient actions were being compared. Nonetheless the authors achieved acceptable results with the normal saline-Syntocinon regimen described here, which justify continued evaluation of the method in a larger series of patients. Second trimester abortion is unfortunately necessary in modern obstetrics and the great variation of published methods indicate that none is entirely satisfactory. Summary: Data is presented for 40 mid-trimester abortions, induced by 0.1% Emcredil (Group 1 — 20 cases) and normal saline (Group 2 — 20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction-abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction-abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of pro-staglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side-effects, it seems to hold a lot of promise for induction of mid-trimester abortion.

A comparative study of the metabolic effects of two combined oral contraceptive preparations was undertaken in seven WHO Collaborating Centres for Research in Human Reproduction. A total of 847 subjects were randomly allocated to one of two pill groups — norethisterone 1mg/ethinyl estradiol 35ug (NET/EE) or levonorgestrel 150ug/ethinyl estradiol 30ug (LNG/EE). An additional 195 women using an IUD served as a comparison group. Blood samples were taken on admission, and at 3 and 12 months thereafter. Both pills induced changes in fasting and 2-hour glucose, triglycerides, total cholesterol, HDL-cholesterol, bilirubin, alkaline phosphatase, albumin, and total protein, but not aspartate aminotransferase. The most dramatic and probably most clinically important changes were an increase in triglycerides and a decrease in HDL-cholesterol. The NET/EE preparation appeared to induce a greater increase in triglycerides, but no significant difference was found between the two pill preparations with respect to HDL-cholesterol changes.

The vasopressor activity of human amniotic fluid was assessed in 46 primigravidas during the third trimester of pregnancy. The subjects included 20 normal and 26 cases of pregnancy toxaemia. For identification of the vasopressor activity of the amniotic fluid, blood pressure measurements were made in the intact rat, and the smooth muscle contraction of the rat ascending colon preparation was determined in vitro. The samples of amniotic fluid showing vasopressor activity were lyophilized and subjected to gel filtration using Sephadex G-100. The various fractions thus obtained were monitored at 280 nm and the pressor activity was re-estimated. It was observed that most of the pressor activity of the amniotic fluid of the toxaemic patients was capable of causing contraction of the rat colon as well as a significant rise in the systolic blood pressure of the intact rat. Furthermore, this activity was found to be heat-labile and was completely blocked by cinnarizine. Fractionation of the amniotic fluid showing vasopressor activity by gel filtration further substantiated the findings reported above. On the basis of these results it was concluded that the pressor activity of the amniotic fluid was due to the presence of an angiotensin II-like substance. Its concentration was found to be higher in the toxaemic group than in normotensive subjects.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.

The effects of medroxyprogesterone acetate (MPA) on the digestive and absorptive functions of the small intestinal epithelium have been investigated in female albino rats. The transport of sodium-dependent glucose was significantly enhanced while sodium-independent transport remained unaltered in drug-treated animals. The uptake of amino-acids was also considerably increased, while Ca++ uptake decreased significantly on administration of the drug at a dose of 35 mg/kg body weight once a week for 1 month. Kinetic studies of glucose transport in the presence of sodium ions revealed that MPA treatment affected the rate of uptake of glucose by elevating Vmax, but the Km value remained the same in treated and untreated animals. The administration of the drug also led to significant augmentation in the activities of the brush border enzymes, disaccharidases, and to an insignificant decrease in alkaline phosphatase. The activities of leucine aminopeptidase did not show any change. The enhancement in sucrase activity might be due to induction of the enzyme because only Vmax was elevated in treated animals. As concerns cellular enzymes, lactate dehydrogenase activity was significantly depressed. This study suggests that MPA also exerts glucocorticoid-like effects on the intestinal tissue.

This presentation gives retrospective analysis of 47 cases of ectopic pregnancy in nulliparous women, admitted in the Gynaecological Emergency services of Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh. Etiological factors leading to ectopic pregnancy in these patients have been presented. Tubal damage in young patients as a result of ascending infections possibly due to sexually transmitted diseases have been discussed. Preventive measures for reducing the incidence of ectopic pregnancy have been emphasized.

Summary: Culdocentesis was carried out in 92 suspected cases of ectopic pregnancy and was positive in 90%. Laparotomy confirmed the accuracy of culdocentesis in 97.5% of the cases of acute tubal rupture, 87.5% of tubal abortions and 80% of ‘intact’ tubal pregnancies.